Developing a Band 4 assistant post in musculoskeletal physiotherapy


To meet the demands of an ageing population with increasing long-term conditions, developing our support worker workforce is vital to enable the physiotherapy workforce to work differently for patient needs. The opportunity exists to maximise the capability of our current assistant workforce and be more efficient, but safe and relevant. Within these parameters we can upskill and grow our own workforce maintaining and sharing skills, and, improving job satisfaction. Musculoskeletal (MSK) physiotherapy provides an ideal environment to implement this, considering the variety of presenting different patient conditions. The objective of this project was to develop a Band 4 (B4) physiotherapy assistant to be confident in assessing, treating and discharging patients using designated pathways.

Following Band 4 initial assessment;
8% of patients referred to qualified staff
60% to group rehab
32% B4 advice, review and discharge


Utilising experience of a B4 role both within our Orthopaedic in-patient department and a comparable musculoskeletal physiotherapy department, an initial job plan was created. To develop the role further, advice was taken from the Chartered Society of Physiotherapy who facilitated information- sharing with other trusts. This enabled the development of ‘local’ clinical pathways constructed into simple, moderate and complex conditions, based on a consistent best practice approach. A comprehensive training programme was devised with ongoing supervision, mentoring and problem solving. Data was collected allowing evaluation of the service.



· · B4 has seen 445 new patients over a 12-month period.

· · Clinic utilisation is up to 15% higher than for qualified staff (Patient Centre data)

· · Data demonstrates that pathways are followed correctly, e.g TKR pathway highlights after B4 initial assessment; 8% of patients referred to qualified staff, 60% to group rehab and 32% B4 advice, review and discharge.

· · Clinical supervision demonstrates pathways being followed appropriately and safely.

· · B4 describes increased job satisfaction with upskilling, including training of more junior staff. Self-assessment demonstrates increased competencies and confidence and feeling valued in the role.

· · Qualitative data demonstrates good patient satisfaction, ‘knowledgeable’, ‘understanding’; ‘alleviated anxiety’ ‘got me better’.

· · Investment in the B4 role facilitated further development of the Band 3 MSK role, increasing the efficiency of MSK service. Alongside this, the creation of an interdepartmental assistant in service training programme, currently led by two assistants has generated more interest in career progression.

· Feasibility to increase the B4 clinic utilisation by making changes at the MSK triage level and potential for more B4 roles within the department in the future. Spot checks of qualified staff caseloads demonstrate 168 patients eligible to be seen by B4

Conclusion(s): Developing a B4 physiotherapy assistant in MSK physiotherapy demonstrates an effective use of resources when trained appropriately, using designated pathways. Investment at this level, leads to increased skills and confidence, job satisfaction and further opportunities for development and career progression for other support staff.

Cost and savings

No further data 


Optimising the capability of our support staff creates the potential for more cost-effective services by shifting the workload appropriately, enabling our qualified physiotherapists to work differently to meet population demands. This project adds to the evidence base for developing physiotherapy support services

Top three learning points

No further data 

Funding acknowledgements

Work was not funded